U. S. DEPARTMENT OF AGRICULTURE, 



BUREAU OF ANIMAL INDUSTRY— BULLETIN No. 67. 
D. E. SALMON, D. V. M., Chuf of Bureau. 



SF 

J\^7 



NECROTIC STOMATITIS. 



WITH SPECIAL RKFERENCE TO ITS 
OCCURRENCE IN 



CALVES (CALF DIPHTHERIA) 

AXI) 

PIGS (SORE MOUTH). 



JOHN R. MOHLER, A. M., V. M. D., 

Onef of Paitiolo^ical Divisi'iti ^ Bureau of Auintal Industry, 



GEO. BYRON MORSE, M. D., V. S., 

Assistaut in Patho/ooiral Division , Bureau of Anivuil tndusiry 




WASHINGTON: 

(iOVKKNMRNT I'KINTINC oPFICR. 
1905. 




Class ^} t" ^ ^ — 



Book 



^liX^ 



ro 



U. S. DEPARTMENT OF AGRICULTURE, 

BUREAU OF ANIMAL INDUSTRY— BULLETIN No. o7. ' /^ C^ 



D. E. SALMON, D. V. M., Chief ok Bureau. 



^f ^ 



NECROTIC STOMATITIS. 



WITH SPECIAL REFERENCK TO ITS 
OCCURRENCE IN 



CALVES (CALF DIPHTHERIA) 

AND 

PIGS (SORE MOUTH). 

BY 

JOHN R. MOHLER, A. M., V. M. D., 

Chief of Paiholoi^ical Division, Bureau of Animal Industry. 

AND 

GEO. BYRON MORSE, M. D., V. S., 

Assistant in Pathological Division, Bureau of Animal Industry. 




WASHINGTON: 
GOVERNMENT PRINTING OFFICE. 

1905. 



"^ 



^onccn0k 






MAY 19 1905 
O.otO. 



LETTER OF TRANSMITTAL 



U. S. Department of Agriculture. 

Bureau of Animal Industry, 
Wasliingtori, I). 61, Fehruary i, 1905. 
Sir: I have the lionor to transmit herewith a manuscript on "Necro- 
tic stomatitis, with special reference to its occurrence in calv^es 
(calf diphtheria) and pigs (sore mouth),*' l)v -Dr. John R, Mohler 
and Dr. Geo. Byron Morse, both of the Pathological Division of this 
Bureau. 

It is definitely known that this disease has been in this country during 
the last three or four years, and it is probable that it has been pres- 
ent a much longer time. It affects calves, pigs, adult cattle, lambs, 
asses, kangaroos, rabbits, dogs, and chickens, but in this countr}' it 
has so far been reported for calves and pigs only. The percentage of 
losses varies greatly, but it is always large. 

I recommend that this manuscript be published as a bulletin of the 
Bureau series. 

Respectfully, 

D. E. Salmon, 

Chief of Bureau. 
Hon. James Wilson, 

Secretary of Agriculture. 



CONTENTS. 

Page 

Introduction 9 

Name and synonyms 9 

Definition 10 

Historical review and geographical distribution 10 

Etiology 12 

A. Predisposing conditions. 12 

B. Active agent {Bacillus necrophorm^) 12 

Bacteriology 12 

Name 12 

History 12 

Morphology 13 

Motility 13 

Staining 14 

Biology 15 

Plate cultures 15 

Shake cultures 16 

Stab cultures 17 

Cultures in fluid media 18 

Action of germicides . IS 

Chemical activities 18 

Pigment production 18 

Odor production 18 

Production of substances that liquefy 18 

ludol formation 19 

Production of curdling ferments 19 

Production of toxins , 19 

Immunity 20 

Occurrence in nature 20 

Pathogenesis 21 

Under natural conditions 21 

Under artificial conditions 22 

Experiments on rabbits 22 

Subcutaneous method 22 

Intravenous method 24 

Experiments on mice 25 

Subcutaneous inoculation 25 

. Experiments on guinea pigs 26 

Experiments on chickens 26 

Experiments on pigeons 26 

Experiments on calves 26 

Subcutaneous inoculations 26 

Sul)cutaneous and intravenous inoi'ulation 28 

Intravenous inoculations 28 

Experiments on sheep.. 29 

Subcutaneous inoculations 29 

Experiments on pigs 29 

Subcutaneous inoculations 29 



CONTENTS. 



Pathology 30 

Symptoms 32 

Course and termination 34 

Infective character 34 

Susceptibility 36 

Economic importance 37 

Differential diagnosis 39 

Prognosis 46 

Treatment 40 

Prophylaxis , 40 

Therapeutics 41 

Relation of animal diphtherias to man 42 

Disposition of meat of affected carcasses 42 

Conclusion 43 

Bibliography 44 



ILLUSTRATIONS. 



Plate 1. Necrotic stomatitis with lesions involving tongue and cheek 16 

2. Fig. 1. — Section of upper lip of calf showing necrosis bacilli. Fig. 

2. — Section of liver of rabbit showing a peripheral area of caseation. 16 

3. Section of lung of rabbit showing metastatic foci 24 

4. Section of lung of rabbit showing felted network of Bacilhn^ 

necrophorus 24 

5. Fig. 1. — Bacillus necrophorus from metastatic focus in rabbit's heart. 

Fig. 2. — Petri dish containing characteristic colonies of necrosis 
bacilli 24 



NECROTIC STOMATITIS. 

WITH SPECIAL EEFERENGE TO ITS OOOUKRENOE IN CALVES (CALF 
DIPHTHERIA) AND PIGS (SOEE MOUTH). 

By Jonx 11. Mohlkk, A. M., V. M. D., 
Chief of Pathological Division, Bureau of Anhnal Industry, 



Geo. Byron Morse, M. D., V. S., 
Assistant in Pathological Division, Bureau of Animal Industry. 

Introduction. 

The vestibular character of the mouth in its relation to the general 
organism makes an}- disease of the oral cavit}' an important matter. 
Mechanic, chemic, and thermic influences ma}' each play a part in the 
production of various disturbances of its mucous membrane, but the 
most frec|uentl y operative of all causes — and most serious, too — are 
the microorganismal. It is these last which render any form of stoma- 
titis serious and constitute the real source of danger in the grave 
forms. Not the least interesting in this last group — and, as we shall 
show, of considerable economic importance, although until recent years 
not recognized in this country — is the affection to which we have given 
the name '"necrotic stomatitis/' Owning similar predisposing condi- 
tions and recognizing a common etiologic agent, its occurrence has been 
noted in calves, pigs, adult cattle, lambs, asses, kangaroos, rabbits, 
dogs, and chickens. In this countr}- it has been reported up to the 
present time onl}^ among calves and young pigs, being probabl}' more 
prevalent among the latter. For this reason and because our investi- 
gations in this disease have been limited to cases occurring in these 
two species only, the following pages will deal with necrotic stomatitis 
of calves and of pigs. 

Name and Synonyms. 

Necrotic stomatitis of calves has been known generally under the 

unfortunate term of "calf diphtheria.'" Diphtheria has a specitic 

cause (Klebs-Loffler bacillus) and a definite histologic picture, both of 

which nre lacking in necrotic stomatitis. The name " calf diphtheria" 

18489— No. 67—05 2 9 



10 BUREAU OF ANIMAL INDUSTRY. 

is therefore a. misnomer. The putholooic process in necrotic stoma- 
titis alwa3's presents the picture of a diphtheric inflammation plus casea- 
tion — that is to sa\% an inflammation characterized bj^ the production of 
a membrane, which, as an essential feature of the disease process, 
undergoes cheesy degeneration. Since this progressive necrosis is 
caused by the necrosis bacillus, the origin of the term " necrotic stoma- 
titis" is self-evident. This disease in calves has also been termed 
gangrenous stomatitis, ulcerative stomatitis, malignant stomatitis, 
tubercular stomatitis, diphtheric patches of the oral mucous mem- 
brane, necrosis diphtherica caseosa, stomatitis diphtherica multiplex, 
and stomatitis membranacea diphtherica. In pigs the affection has 
been designated ulcerative stomatitis, sore mouth, and canker of the 
mouth. 

Definition. 

Necrotic stomatitis is an acute, specitic, highly contagious inflamma- 
tion of the mouth, occurring enzooticalh^ in many species of animals 
and characterized locall}^ by the formation of ulcers and caseo-necrotic 
patches and by constitutional s3^mptoms, chiefly toxic. The disease is 
in no Avay related to diphtheria of man. 

Historical Review and Geographical Distribution. 

During the last few years farmers and cattlemen of this country 
have noted the increasing occurrence of sore mouth among the 3'oung 
animals of their herds. Instead of healing of themselves, as the usual 
forms do, these cases, if untreated, die. Careful study of some of 
them has resulted in their identification with cases first reported by 
Dammann**" in 1876 from the shore of the Baltic. His model clinical 
investigations, making the description of the disease suitable for 
to-day, and his accurate postmortem findings were marred by subjec- 
tion to the then dominating assertion of Eberth, "without micrococci no 
diphtheria." Finding micrococci everywhere present in the diseased 
tissues of the mouth, and failing to recognize the fatal results in his 
experimental inoculations as due to septicemia, Dammann pronounced 
the disease identical with diphtheria in man. To what extent the 
malady occurred before his time it is difficult to determine, but from 
the fact that his clinical observations were soon confirmed b}^ a number 
of contemporary veterinarians, it is probable that at the time of his 
writing it was not very uncommon. ^'^ In 1878, Blazekovit^^ gave an 
extensive report of sixteen cases (fourteen fatal) of calf diphtheria in 
Slavonia, and, in 1879, Vollers,^** adopting Dammann's theory, recorded 
four cases of the same disease in Holstein. Near the close of 1880, 
Lenglen" described quite accurately the local manifestation and gen- 

«The figures refer to the bibliography at the end of this bulletin. 



NECROTIC STOMATITIS. 11 

eral sjMiiptoms of the disease a^ noted by him in a series of ten cases 
in the northern part of France. Under the title of gangrene of the 
mouth in young calves, he identified the disease with gangrenous 
stomatitis, or noma, in children, and, as predisposing causes, associated 
the eruption of the teeth with bad sanitary and dietetic conditions. 
His article attracted the attention of MacGillivray,*" •'" of Banff, Scot- 
land, who published several articles during 1881-82, describing his 
experiences with the same disease, and asserting that it was a tuber- 
cular stomatitis rather than diphtheritis, or gangrenous stomatitis. 
During these two years there entered into the controversy thus started 
in the Veterinary Journal and the Veterinarian, the following persons 
wnth reports of their own cases: Campbell,*^ Cole,** Fleming,^® Gunn,^' 
James,-** Metherell,'' Smith,*''' and Steel."* In 1884, Loffler*' isolated 
and described the bacillus of human diphtheria, thus destroying all 
previous theories as to the cause and relation of micrococci with that 
disease. Pursuing similar investig-ations, he the same year isolated 
from diseased tissues in cases of so-called calf diphtheria a long slender 
thread-like bacterium, which he described and demonstrated as the cause 
of this affection. Loffler thus proved diphtheria of man absolutely 
distinct etiologically from that disease, so called, in calves. In 1903, 
Mettam""^ observed this affection in Ireland in the calves of the prov- 
ince of Munster and in DuVjlin, while McFadyean*'* has mentioned his 
familiarity with its prevalence for some years in various sections of 
England. We have no exact knowledge Of the existence of the disease 
in this countr}^ prior to 1897, when it was recognized by one of us in 
southwestern Texas. It was later observed in rather serious outbreaks 
in 1902 and 1903 in Colorado, Wyoming, and South Dakota. 

Bang,^ in his notable work on the necrosis bacillus, was the first 
to announce this parasite's causative relation to the deep necroses 
often affecting the mouths of hogs. However, Johne,^^ in his 
pathological reports for 1890, seems to have recognized the disease in 
pigs, although it was not until 1893 that Schlegel,^** working in con- 
junction with Johne,^'* proved the relationship of the Bacillus necroph- 
OTus to diphtheric inflammation of the tonsils, phar3mx, and larynx 
in hogs. Kitt^^ was also able to recover the causative agent of this 
disease from the diphtheric lesions of the larynx and phar3'nx of calves 
and pigs in 1893. In 1903, Lauritsen*** described a necrotic inflam- 
mation of the mouth in j^oung pigs, believing, though not demonstra- 
ting, BaciUus iiecrophorus to be the cause. 

The outbreaks of this disease in pigs, which we were onaljled to 
stud}^, appeared in an enzootic form in western Tennessee, and, at the 
Athenia quarantine station, among a herd of young Berkshire hogs 
recently imported, from which cases the Bacillus necropliorus was 
recovered. 



12 bureau of animal industry. 

Etiology. 

Necrotic stomatitis is due to a specitic infection. It is an inocula- 
tion disease and occurs as a result of the already abraded lining- mem- 
brane of some part of the oral caA'ity being invaded by the BactUm 
necroplioTim. 

\. — PREDISPOSING CONDITIONS. 

These prepare the nidus for the active ag'ent. The necrosis bacillus 
will not develop on a normal mucous membrane; its invasion is always 
secondary. Opportunity for infection of the mouth is afforded by 
a catarrhal inflammation of its lining-, by a break in the integrity of 
its protective covering-, or by the role played by the bacterial flora 
of the mouth in damaging its cells and tissues. Here may be men- 
tioned, also, irritant foods, rough forage, veiy hot or very cold drink- 
ing water, chronic and debilitating diseases, and damp, unsanitary 
pens. Furthermore, as will be pointed out later, some predisposition 
appears necessary for the development of necrotic stomatitis. In part, 
this is individual, for whereas the disease is distinctly one of young 
animals, some of these are more hig-hly susceptible than others. 

B. — ACTIVE AGENT (BACILLUS NECROPHOKUS). 

Bacteriology." 

NAME. 

This organism has been variously known as Bacillus der Kdlher- 
dijjhther ie (Lo^er),^^ 188-i; BaciUux diphtlier'tx vitulorwin (Lofl[ler) ^'; 
Bacillus necrojpliorus {J^\\\^g^^^^ 1880 ; B(iciUus Jiliforrnis (Schiitz)," 
1887; N'ekrosebacillus ij&2ing)^^ 1890; Streptothrlx cu^i/ci/Z/ (Schmorl),'*'' 
1891; Actinomyces cunicidi {^2k^}Qv'\n\)^^'^ 1892; Bacillus necroseos (Salo- 
monsen),®^ 1894; Bacillus des Kalhernoma (Ritter)," 1895; and Strep- 
tothrix necropJiora (Kitt),^* 1899. 

Until authors are more agreed as to the possession by this organism 
of the character of branching, a feature not observed during the course 
of our investigations, it will be well to consider it as belonging to the 
Bacteriacete and allow priority to designate it Bacillus necrophorus 
(Fliigge). 

HISTORY. 

First observed by Koch, ^'^ it was not isolated and described until 
Lotfler, in 1884, demonstrated it as the cause of the disease erroneously 
called by Dammann^ calf diphtheria. It remained for Bang to recog- 

" It is with pleasure that we acknowledge our inde1)tedness to Dr. B. Bang and Dr. 
W. Ernst for sending us cultures of Bacillns vecrophorvs with which to compare our 
organism. 

'' Without doubt Dammann, on page 12 of his article, in his description of the 
tangled network of fibrin threads in the deeper layers of the pseudomembranous 
deposits, really refers to tlie filaments of Bacillvs necropliorus. 



NECROTIC STOMATITIS. 13 

nize its varied activities in the production of coagulation necrosis and 
describe it as the NekrosebaciUus. A 3^ear later Schmorl made public 
his careful investigations of a spontaneous rabbit disease in his labora- 
tory, resulting in the recovery of this same organism which he, either 
not knowing of Loffler's and Bang's labors or failing to identify his 
organism with theirs, called Streptothrix cunicuU. Since then numer- 
ous investigators have confirmed the work of the foregoing scientists 
and demonstrated a still wider sphere of pathogenic relationship, the 
latest being the proof furnished by this laboratory of the etiologic con- 
nection of BdciUu.s necropliorus with foot-rot in sheep. The morpho- 
logic and biologic characters have been quite thoroughly worked out 
by Bang, Schmorl, and Ernst. 

MORPHOLOGY. 

Bacillus necroj)horus is essentially a pleomorphic organism. It 
varies, according to nutrient soil and age of culture, from coccoid 
forms to filaments over 100;< in length and from 0.T.5 to 1.5/^ in width. 
The longer forms appear as slender, undulating, beaded filaments. 
Generalh', in the tissues these threads are matted together into an 
intricate network, like a mass of hair or even the more compact felt. 
The same appearance may be found in colonies. Frequently the fila- 
mentous forms present one wide oi" clubbed extremity, with the other 
extremity tapering. On the other hand, the older cultures — either 
animal tissues or artificial media — exhibit almost exclusively bacillary 
forms of various lengths, some so short as to be easily mistaken for 
cocci. Involution forms may be present in an}^ culture, but certain 
media, notably that composed of a mixture of agar, gelatin, bouillon, 
peptone, and salt are particularly favorable to their development. 

Motility. — Motion has not been observed in our experiments; in 
fact, it has been reported by Schmorl only. He examined the pleural 
exudate in hanging drop. He says: '\ 

The shorter bacillus-shaped forms are mostly motile; they travel slowly through 
the visual field with a serpentine, or crawling, motion, but generally come very 
quickly to rest. The longer threads are for the most part absolutely motionless; only 
in the entirely detached forms does one notice pendulous movements being slowly 
executed. The signs of motility can be demonstrated only when the material for 
observation has been taken from an animal just killed or just dead. If it has been 
dead a longer time, one finds rods and threads altogether in the resting condition, 
from Avhich they can sometimes be aroused by making the observation on a warm 
stage in a vacuum. Most of the rather thin and pale threads possess a character- 
istically stiff appearance. They fioat along sometimes completely extended; at 
other times they exhibit slight winding motion. But very seldom does one find 
specimens which appear spirally twisted. 

Over against this statement of Schmorl ma}' be placed that of Ernst:" 

The merely feeble, oscillating, molecular movements of the rods and the pendulous, 
serpentine movement of long, undulating threads in changes of position, according to 



14 BUREAU OF ANIMAL INDUSTRY. 

the law of gravity, permit no positive decision as to motility. In order to examins 
the bacteria as to their motility I employed cultures ; and since young, 36-hour, cul- 
tures in the hanging drop showed no active changeof place beside the ordinary molec- 
ular motion, and furthermore, since in the employment of material from cultures 
whose growth was just becoming visible (24-36 hours) , flagella were not demonstrated 
by mordants which gave good results in control experiments with edema and cadaver 
bacilli as well as colon forms, a denial of motility would appear perfectly just. 

In this laboratory the examination for motility was made with fresh 
cultures and with tissue from animals within one hour after death, 
both b}^ means of hanging drop and by the application of flagella stains. 
In no case was it possible to claim motion for these Ijacilli. 

Staining. — The necrosis bacillus stains readily with the ordinary 
aniline dyes, Loffler's methylene blue, and Ziehrs carbol-f uchsin, pro- 
ducing particularly good effects. Alkaline toluidine blue (1 per cent 
solution), while not giving the brilliant effects of fuchsin, makes 
perhaps the best reagent for routine use. The slide, or cover slip, 
dipped in the stain, immediateh^ washed in water and mounted, is a 
very rapid and satisfactory method of bringing out the beaded appear- 
ance of the organism. 

In the study of fresh tissue smears, it is usually sufficient to make a 
film on a slide with a teased particle of the suspected tissue, and, after 
the usual preliminaries, stain with one of the ordinary dyes mentioned, 
preferably methylene blue or toluidine blue. Whenever it was desired 
to employ differential staining, we found the following procedure to 
answer all requirements: The stains are kept ready for use in wide- 
mouthed bottles. Prepare the film on the slide in the usual manner, 
fix in the flame, dip it from two to five seconds in a 1 per cent alka- 
line toluidine blue, wash it thoroughly in water, counterstain it in a 
0.2 per cent Neisser's Vesuvian brown, wash it in water, dry, and then 
mount it in balsam. 

An excellent method of double staining was devised for Bacillus 
necrophoriis by Bang. Bits of the ne(!rosed tissue were hardened in 
Mailer's fluid, thoroughly washed, and further hardened in alcohol. 
(Alcohol alone he did not find suitable.) The sections are placed a few 
minutes in toluidin-safranin (produced like aniline-gentian violet), 
dehydrated by means of an alcoholic solution of safranin; after this, 
fluorescin clove oil, pure clove oil, alcohol, watery methyl green, 
alcohol, xylene, balsam. The bacilli are stained a beautiful red, while 
the tissue is stained green; no Qther investigated bacteria can stain in 
this manner. 

Mention has been made of the beaded appearance of the Bacillus 
necrophorus in stained preparations. This is noticeable equally in tissue 
smears or sections and in films from cultures. The longer rods and 
threads particularly exhibit this characteristic. It is due to the occur- 
rence in the filaments of unstained spaces which were at first thought 
to be spores. Spore-staining methods, however, do not alter them. 



NECROTIC STOMATITIS. 15 

Careful study of this peculiarit}- reveals several phases of it. Some- 
times a thread will be most regularly marked off into alternate sections 
of stained and unstained material; again, decided irregularity charac- 
terizes the arrangement — long vacuole-like inclusions alternating with 
shorter stained squares or Imcillus-like spaces of stained material may 
alternate with shorter colorless portions; again, the vacuoles may 
appear like a chain of colorless rods lying on a ribbon of blue or what- 
ever color may be used for the stain. Sometimes the stained material 
is so little in quantitv that the thread seems like a string of spores, 
oval or rod shaped, with thin, deeply stained partitions between them. 
On the other hand, the filament presents itself as an unstained tube 
with a regular succession of deeply stained coccus-like granules much 
resembling streptococci, or these granules may be alternately arranged 
alono- the sides of the tube. 



Cultivation of the Bacillus neerophmnis is not easy. It is an abso- 
lute anaerobe. Investigators differ concerning its requirements as to 
temperature. Nocard and Leclainche^^ give 30° to 40'^ C. as the 
limits of growth, with the optimum at 87° C. ; Jensen adopts the same 
extremes, but places the optimum at 34° C. ; whereas, according to 
Ernst, development occurs only between 86" and 40° C, and the opti- 
mum is 89°. Our own investigations have shown that 30° to 40° C. 
represent the extremes of temperature at which the ordinar}^ work of 
the laborator}" may be satisfactorily carried on; nevertheless, we have 
on different occasions been able at 28° C. to grow in agar-bouillon 
•shakes typical colonies, which responded to the usual tests of mor- 
phology, odor, and pathogenesis. With us the optimum was 35° C. 

The usual culture media of the laboratory are either unsatisfactory 
or altogether inimical to the development of the necrosis bacillus. 
Agar-agar was often employed with only passable results, but more 
satisfaction was obtained from the following combinations: Agar- 
bouillon (A-B); agar-gelatin (A-G); serum-agar (S-A); serum-agar- 
gelatin (S-A-G); and two suggested by Ernst — 1..5 per cent agar in a 
peptone-salt-bouillon (A-B-P-S) and 0.7 per cent agar and 7 per cent 
gelatin in bouillon with .5 per cent peptone and 2.5 per cent salt 
(A-G-B-P-S). The first four mixtures were usually prepared in the 
proportions of equal parts, although other proportions were adopted 
for the purpose of var3'ing the consistence of the medium. Fluid 
blood serum, milk, rabbit bouillon, and Martin's bouillon were also 
employed. 

Plate Cultures. 

Bouillon agar. — Great difiicult}^ was experienced in getting the 
organism to develop colonies in Petri dishes. Numerous attempts 
were made by displacing air with hydrogen in a hydrogen jar, and by 



16 BUEEAU OF ANIMAL INDUSTRY. 

the formation of a vacuum hj withdrawing the air under a bell jar by 
means of a vacuum pump, but success was not attained in any instance. 
Recent!}' it was endeavored to grow the organism in Petri dishes placed 
in a closed jar containing a solution of pyrogallic acid rendered alka- 
line by sodium hydrate. This method, which permitted the presence 
of only the inert nitrogen gas, finally resulted in characteristic colo- 
nies occurring throughout the medium with the formation of numerous 
gas bubbles. Several of these colonies in the dish of the second dilu- 
tion (pi. 5, iig. 2) grew so close to the surface that some filaments 
extended to the upper stratum, and could be removed by means of a 
platinum needle. In about forty-eight hours after exposing the plates 
to this method, small, pinhead-sized, dirty-white, opaque, round colo- 
nies, possessing no distinctive features, were visible to the unaided eye 
below the surface. Man}^ small round or oval gas bubbles could also be 
observed. By means of a small magnifying glass these colonies were 
seen to possess a yellowish-brown center surrounded by a thin, light, 
almost translucent border^ which, under the mici'oscope, appeared 
lioccose. After three daj^s the colony presented to the naked eye a 
woolly appearance, and the microscope now revealed the central struc- 
ture as a felted maze of threads and the floccose character of the border 
as long, wav}' filaments. 

Shake Cultures. 

Aga/'-hoi(lllon. — In eighteen to twenty-four hours after inoculating' 
a tube either from necrosed tissue or from a colony in another tube, 
or with a loopful from the depths of a pure Martin's bouillon culture, 

Description of Plate 1. 

Tongue and cheek of calf showing lesions of necrotic stomatitis as a result of natu- 
ral infection. Notice the zone of thickened granulated tissue surrounding the dry, 
cheesy, grayish-yellow areas of necrosis both in the tongue and cheek. 

Description of Plate 2. 

Fict. 1. — Section of the upper lip showing the necrosis bacilli in their special role 
of producing a deeply penetrating necrosis. The cuticular layer has suffered com- 
plete coagulation necrosis and caseation. The drawing depicts the bacilli in the act 
of carrying the necrosis down between the papillae. Lodged in the interpapillary 
epithelium they have completely destroyed the portion where they lie and have 
exerted their toxic influence on the cells to the left. To the right is a section of a 
papilla whose suprapapillary layer of epithelium has been destroyed next the bacil- 
lary mass preparatory to the attack on the connective tissue framework of the jjapilla. 
Stained with methylene blue and eosin. Magnified about 640 diameters. 

Fig. 2. — Section of liver of rabbit No. 1183, inoculated with an emulsion of necrosed 
tissue obtained from rabbit No. 1166, which had been inoculated with material from 
a pig affected with necrotic stomatitis. The periphereal area of caseation delimited 
bj' the well-defined line of demarcation is the result of the extension of the necrosis 
by contiguity of structure as the abdominal wall at this point was adherent to the 
capsule of Glisson by a plastic exudate. No other areas of necrosis were observed in 
the liver. Stained by hematoxvlin and eosin, and magnified about 22 diameters. 



Bulletin No. 67, B. A. I. 



Plate 1. 







NECROTIC STOMATITIS WITH LESIONS INVOLVING TONGUE AND CHEEK. 



Haines del 



Bulletin No. 67, B. A. I. 



Plate 2. 










y 




•\-:t' 












\'' •'■ 






%^ii 



.M 







Fig. 1 "Section of Upper Lip of Calf Showing Necrosis Bacilli. 



. ^^f(t4^''^0^-% 




\ 



rm 



Fig. 2. -Section of Liver of Rabbit Showing a Peripheral Area of Caseation. 



Haines del 



:^rECROTIC STOMATITIS. 17 

the tube is studded with small oval gas bubbles. At this time, also, 
rarely with the A-B medium, frequently with the softer forms, as 
S-A-G, A-G (2:1), A-B-P-S, and A-G-B-P-S, the column of culture 
medium will be transversely ruptured in one, two, or more places by 
the pressure of the gas. In fortj^-eight hours these sections will often 
be separated 2 to 5 mm. and even more from each other. We ha\e 
sometimes seen this gas formation go on for the next two days, suffi- 
ciently strong to raise the upper portion of the medium 2 cm. The 
dilution from the above-described tube — tube 2— would often follow 
tube 1 quite closely in the quantity of gas bubbles formed, though not 
in the breaking up of the medium. Tubes 3 and 4 would usually 
show a great diminution in the quantity of gas bubbles and no break- 
ing up of the medium. 

In the development of the growth, our experience tallied quite 
closely in a few notable points with that of Ernst. For instance, 
shakes sown with necrosed material would often show, after thirty-six 
to forty -eight hours, a fine gra3'ish white mist of cloudiness at the lower 
portion of the tube. In our experience, even with slight magnifica- 
tion, it was possible to detect no particular structure. A film made 
from this portion of the culture medium would always show beaded 
forms. Again, when the medium used was jelly-like in consistence, 
the unabsorbed gas, instead of remaining as bubbles at the point formed, 
would gradually float upward toward the surface. The original seat 
of these bubbles and the pathwaj's along which they had risen v\'ould 
be coated with a fine bacterial growth. Thus would be formed 
numerous filmy ribboHS, extending from near the surface down into 
the depths of the tu])e, where they would be anchored bj^ a crescent- 
shaped bod}'. The time and rate of growth and appearance of colonies 
in the tube are sufficiently described in the description of the plates. 

Stab Cultures, 

Agm-'-agaf. — Near the close of the second day a few grayish-white 
colonies make their appearance at the bottom of the needle track. 
Gradually these increase from below upward to within 1-1. .5 cm. of 
the top of the stab canal. Thus is formed a thin, narrow, opacjue, 
yellowish or grayish white line of growth surrounded by a thin whit- 
ish cloud, wdiich on slight magnification is seen to be composed of 
minute wav}^ threads. 

Along the needle track, and, if the medium is not too hard when 
inoculated, throughout the culture may be seen numerous round and 
oval gas bubbles. 

Serum-agar. — Time and height of bacterial growth and gas forma- 
tion are like the preceding. At times the needle track is the center of 
a whitish film or merely a thin line of cloudiness of the medium; 

18489— No. H7— 05 3 



18 BUREAU OF ANIMAL INDUSTRY. 

again, the growth may be denser, similar to that described for agar- 
agar. The serum is never liquefied, although in very old cultures it 
will be natural that the zone of cloudiness referred to has spread 
nearl}^ to the walls of the tube. 

Cultures in Fluid Media. 

Bouillon.— rThe organism can be grown in ordinar}" peptonized 
beef broth, rabbit bouillon, and in Martin's broth, the maximum 
development occurring at the temperature of 35^ C in a hydrogen 
jar. The bouillon becomes turbid with the formation of some gas 
which is noticeable by the surface bubbles. Later the bacillary masses 
sink to the bottom in the form of whitish viscid Hakes, causing the 
fluid to become clearer. The cultures have a peculiar odor, very char- 
acteristic, which will be referred to later. There is no film formation, 
but a tendency to develop a ring around the border of the medium has 
been observed. (See "^Milk" and "Fluid serum," on next page.) 

Action of Germicides. 

In determining the germicidal power of disinfectants a measured 
volume of a forty-eight-hour bouillon culture of the necrosis bacillus 
was intimatel}' mixed with an equal volume of the disinfecting solution, 
thereby reducing the strength of the germicide to one-half. Three 
platinum-wire loopfuls were then transferred to fresh rabbit bouillon 
tubes after varying periods of exposure. After an exposure of 1 
minute in a 2 per cent solution of carbolic acid the bouillon tubes 
showed growth, but in the tube representing a two-minute exposure 
no development occurred. With bichloride of mercur}- an exposure of 
nine minutes to a 20S ,t solution prevented growth. Formalin in the 
strength of 2^ per cent solution (1 per cent formaldehyde) killed the 
organism in thirteen minutes. 

Chemical Activities. 

PIGMENT production. 

Chromoofenesis is wantine-. 



odor production. 



All cultures develop a substance or substances which evolve an odor 
well described by Ernst as between the odor of cheese and that of glue. 
The stench is so characteristic that the presence of the bacillus is 
recognized at once in the tissues of either natural or experimental 
infection as well as in cultures on artificial media. 



production of SUBSTANCES THAT LIQITEFY. 



Gelatin is not liquefied. The growth of the bacillus is likewise 
without effect on hardened blood serum. 



NECKOTIC STOMATITIS. 19 



INDOI, FORMATION. 



Indol is formed and ina}' be demonstrated in three-days-old cultures 
made in Martin's bouillon. 



PRonrrxioN OF ctrdlixg ferments. 



Milk is not coagulated nor is acid produced. Fluid serum is 
coao'ulated. 



PRODrCTIOX OF TOXI.VS. 



That the necrosis bacillus produces a toxin is evidenced, not by the 
isolation of the same from artificial cultures, but by (1) the character 
of death in the disease, (2) the quality of the rigor mortis, and (3) the 
study of the pathologic histology. 

The toxic character of death is not particularly noticed in animals 
suffering from stomatitis when inappetency and inabilit}' to take 
nourishment have produced an enfeebled condition. Nor, again, is it 
noticeable in those animals which die with embolic foci in liver or 
lungs, the symptoms arising from the diseased organs often masking 
the signs of intoxication. However, rabbits inoculated subcutaneously 
in the back will persist, without an}' other sign of the disease except 
the abscess, for about five or six days. Suddenh% on the sixth or 
seventh da}", without any premonitory signs, the rabbit will be thrown 
into convulsions, corning out of one to lie with its head turned side- 
ways and buried in the bottom of the cage until another attack, dying 
usually in a few hours after the first convulsion. Quite often in these 
cases the local lesions will not be sufficient to directly produce death, 
not being very extensive, and not involving any important organ. 
Such a course as this points unmistakably to a toxinemia which has 
attacked the nervous system. 

The limits of this article do not permit a discussion of the factors 
entering into the production of cadaveric rigidity. For our present 
purpose it is sufficient to call attention to the fact that the intensity 
and long duration of the rigor mortis observed in the experiment ani- 
mals and described later in this paper comports perfectly with the 
well-known fact that the presence of toxins in the blood promotes 
muscular rigidity. 

It may be stated with positiveness that Bacillus necvopliorus does 
not enter an unimpaired tissue. Most, if not all, of its infections with 
which we are acquainted require for their inception a break in the con- 
tinuity either of mucous meml)rane or skin. A histologic study of an 
affected area, elsewhere examined in greater detail, reveals a center of 
completely destroyed tissue marked by an entire absence of the spe- 
cific bacteria in question. The boundary of this dead area is formed 
by great bundles of filaments of Bacillmi necrophorus, large numbei's 
of leucocytes, and a fair sprinkling of tissue cells whose nuclei still 



20 BUREAU OF ANIMAL INDUSTRY. 

respond to stains. The immediately adjoining- border of surrounding- 
health}" tissue is seen when carefulh" examined to possess numerous 
cells whose protoplasm has been more or less destroj^ed, and in among- 
these dying cells a few scattered filaments have advanced like skirmish- 
ing parties before the main army. It is a true picture of a bacillary 
invasion of tissue begun by means of the noxious effects of a soluble 
toxin. 

Thus far all attempts to recover the toxic substance either from cul- 
tures or the bacilli themselves have failed. From this, Jensen,'^ whose 
assistant, L. Bahr, has made the onl}^ experiments thus far recorded, 
assumes that either the necrosis bacillus forms these substances only 
in the living animal or they are of such volatile character that they 
are destroved as quickly as they are formed. 

IMMUNITY. 

The literature of Bacillufi necrophorus has contained no word on 
acquired immunity until the article by C. O. Jensen ^^ referred to above. 
This eminent investigator and early worker with the necrosis bacillus 
states that his assistant, Bahr, has demonstrated by experiments not 
3"et published that intravenous injections of cultures of the Bacillus 
necrophorus carefully given to goats protect them from quite large 
quantities of the same given subcutaneously. Jensen further states 
that Bahr has produced in the same manner an immunit}" in guinea 
pigs from intraperitoneal injections. In view of the fact that most 
investigators pronounce the guinea pig almost if not quite absolutely 
immune, the statement needs further elucidation. On the contrary, 
while we are not willing yet to build any hypothesis upon it, we find 
that our reinoculation experiments have given us the impression that 
susceptibilit}^ is increased thereby rather than diminished. 

OCCUKRENCE IN NATURE. 

There is hardly room to doubt that the Bacillus necrophcrus is a 
normal inhabitant of the healthy intestine of at least one species of 
our domestic animals — hogs — and possibly of the cow and horse. It 
is also found in the manure, and therefore in soil contaminated with 
the latter. Bang's"^ discovery of the association of the organism with 
the necrotic processes in the intestine in hog cholera, and also as cause 
of an intestinal diphtheritis in calves secondary to an intestinal catarrh ' 
seemed to require the intestine as the normal habitat of the necrosis 
bacillus. Could this be demonstrated we should then have an explana- 
tion of the remarkably ubiquitous character of the organism as exhibited 
in the wide diversity of diseases caused b}' it. In this manner could 
be explained its relation not only to the necrotic inflammations occur- 
ring in the vagina and uterus, but also to all the external necrotic 
processes. This Bang succeeded in doing. He twice made inocula- 



NECROTIC STOMATITIS. 21 

tions of the intestinal contents of health}' hogs with the result of 
demonstrating the presence of Baenius neci'Oj>lu)ni><. An analogous 
investigation by him of the intestinal canal of a cow was not so 
successful. 

Pathogenesis. 

Very few organisms exhibit a wider range of pathogenesis. Accord- 
ing to clinical observation the necrosis bacillus has so far been found 
pathogenic for cattle, sheep, goats, antelope, reindeer, red deer, roe 
deer, horses, asses, hogs, kangaroos, rabbits, dogs, and chickens. 
Experimental work adds to the foregoing list mice and, under special 
conditions, guinea pigs and pigeons. 

It is probably safe to assert that no tissue of the bod}- of a suscep- 
tible animal is safe from its destructive influence. 



UXDEK NATURAL CONDITIONS. 



Natural infections induced by BaciUus ni^crophorus may be consid- 
ered as follows: Necroses of the skin, hoof, muscle, cartilage, mucous 
membranes (mouth and uppor air passages, digestive tract, genital 
tract), navel, and viscera. 

Necrosis of tJie skin in horses has occurred enzootically on a large 
breeding farm, the necrosis appearing on portions of the skin exposed 
to pressure of the harness. A necrotic form of scratches has also been 
shown to be a local infection of Bacillus necrophorus. Gangrenous 
pocks in cows have the same origin, and consist of an acute necrotic 
inflammation of the skin and soft parts of the teats. In hogs such a 
necrotic process has occurred in the skin of the muzzle, of the outside 
of the lips, of the feet, and, in sows, of the udder. 

Necroses of the ho(f include in horses a progressive necrosis of the 
soft parts of the hoof, often involving the bones and cartilages; in 
cows, reindeer, and roe deer, panaritium, or so-called foot-rot, involv- 
ing tendon sheaths, tendons, bones, and joints; in sheep, foot-rot, 
recently shown to be due to the necrosis bacillus. 

Necroses of muscle have been reported in connection with a granu- 
lating wound of the inner side of the hind leg of a cow, also as a result 
of the passage of a foreign body from the stomach into the heart 
muscle, and also in a case where a cow's heart, kidney, and some of 
the voluntary muscles were affected. 

Necroses of cartilage are represented l)y those already included 
under hoof necrosis, b}^ quittor, or fistula of the lateral cartilages, and 
by the laryngeal cartilages in manj'^ cases of necrotic stomatitis. 

Necroses of hone have been reported in association with the hoof 
necrosis of various animals, in the vertebrae in the course of some cases 
of necrotic stomatitis, and in the turbinated bone of the horse. 

Nec7'oses of mucous membranes may ho, regarded as quite frequent. 
Those of the mouth and upper air passages are fully discussed in this 



22 BUREAU OF ANIMAL INDUSTRY. 

paper, and have been recoo-nized in the calf, adult cattle, pigs, sheep, 
kangaroos, rabbits, asses, dogs, and chickens. No less sensitive are the 
mucous membranes of the digestive tract. In pigs the upper portion 
of the esophagus, b}^ extension from the mouth, and in calves the 
esophagus in its entire length, have been afi'ected. In hogs these 
"necrophorus"' patches have been found in the stomach, small intes- 
tine, cecum, colon, and rectum. In horses they have been demon- 
strated in the colon; in cattle, in the rumen, in the reticulum, and in 
the small intestine; and in the deer and antelope, in the stomach. 

The mucous membranes of the genital tract of cows that have 
recently calved are often invaded by the Bacillus necrojjhorus^ result- 
ing in a necrotic vaginitis and a necrotic metritis. 

Navel disease in calves and lambs ''^ is dependent in a considerable 
number of cases on infection of the wound b}" the necrosis bacillus. 

Bacillary necrosis of the heart, lungs, liver, kidney, and spleen, 
also of the udder, have all been reported as the result of metastasis 
from the original seat of the disease, in necrotic stomatitis, necrotic 
scratches, the various forms of foot-rot, and infection of the genital 
passage. 

The classic example of Bacillus necrophorm in mixed infections is 
hog cholera. Here it has been proved unequivocalh^ that the deep 
necroses and so-called diphtheric processes occurring in the body of 
a pig affected with hog cholera are due in some cases to the invasion 
of the necrosis bacillus. It has also been found as a secondary invader 
in the necrotic patches in so-called fowl diphtheria. 

UNDER ARTIFICIAL COXDITIOXiS. 

The pathogenicity of Bacillus necrophorus under artificial conditions 
w^as tested upon rabbits, mice, guinea pigs, chickens, pigeons, calves, 
sheep, and pigs, in order to establish its causal relation to the disease 
in question. 

Experiments on Rabbits. 

Subcutaneous method. — These animals are highh^ susceptible to the 
action of the Bacillus necroplwrus., and to this susceptibility is due 
the ease with which the presence of the germ in diseased tissue 
may be demonstrated. A bit of tissue adjacent to the border of 
the necrosed area is emulsified in a normal saline solution. The 
subcutaneous inoculation of a rabbit with 0.5 c. c. of this emulsion 
will result in the death of the animal within one week. In order 
to free the tissues of the experiment animal from other forms of 
microorganisms naturally present in material taken from such an 
exposed place as the mouth, it is advisable to use a second or even a 
third rabbit. The first rabbit will, however, in spite of the contam- 
inated material used in its inoculation, show very characteristic lesions. 



NECROTIC STOMATITIS. 23 

which can be referred to the action of no organism other than the 
bacillus of necrosis. The chief of these typical changes will be noted 
at the point of inoculation, where, lying beneath the skin and extend- 
ing down for a greater or less depth into the muscular tissues, is found 
an irregular area about 3 to 5 cm. in diameter. This area offers to 
the naked eye much the appearance of a flattened mass of soft, fresh 
putty, and to the nose the penetrating odor alread}" referred to as 
between the smell of cheese and that of glue. This pulpy, yellowish 
white, malodorous mass is the detritus of muscular, fatt}^ and vascular 
tissues which have l)een attacked and destro^^ed through the presence 
of the necrosis bacillus as well as by its effective poisons. Reaching 
out into the surrounding tissues for about 4 cm. in all directions 
is found a zone of inflammatory tissue, and the sul)cutaneous and 
muscular tissues of the abdominal regfion are inflamed and edematous 
through extension by gravitation of the disease process from the local 
lesion caused l)y inoculation. Not seldom in these cases is there to be 
observed a marked development of gas bul)})les. Frequently that 
portion of the large colon adjacent to the diseased abdominal wall is 
greatly injected and adherent to the parietal peritoneum by a plastic 
exudate containing numerous short and long forms of the l)acillus of 
necrosis. This part of the peritoneum is also inflamed and presents 
petechial hemorrhages. Examination of the soft mass found in 
the necrosed area at the point of inoculation shows that it is 
penetrated in every direction b}^ long thread-like bacilli, and 
the subcutaneous inoculation of a second rabbit with a small scraping 
from this mass serves to eliminate a large proportion of the contami- 
nating organisms. Because of the greater purity of the material now 
used, the inoculation will not result fatally until a period usually from 
eight to fourteen days, although occasionally death has l)een prolonged 
until nineteen, and in one case twenty-three, days. In many instances 
it will be found that this longer period of time has proved sufficient 
to allow the circulation to take up a few of the bacilli and deposit 
them in the plexuses of the lungs, liver, or kidnej's, where small, 
yellowish white spots of necrosis will result, which may be readily 
peeled out as if in a capsule. From these secondary visceral necroses, 
pure cultures of the Bacillus necrophorus may now be obtained, and its 
further development secured by the utilization of anaerobic methods 
of culture. The injection of 0.5 c. c. of these pure cultures under the 
skin of the back produced the same characteristic yellowish white area 
of muscular necrosis about the point of inoculation and the peculiar 
penetrating odor so constant with this bacillus. The course of the 
disease is about the same as when an emulsion of the fresh tissue has 
been injected, and, in those cases in which life was prolonged several 
weeks, metastatic areas of focal necrosis were always noted. The 
approach of death is usually indicated by convulsions; the animal 



24 BUREAU OF ANIMAL INDUSTRY. 

comes out of one to be seized with anotlier, death general!}^ resulting 
in a few hours after the onset of the first convulsion. In the majority 
of rabluts that succumbed to this disease, a marked rigor mortis was 
observed, especially noticeable in the hind quarters, causing the back 
to be arched and the legs contracted as if in a tetanic spasm. Micro- 
scopic examination of tissue taken from the necrosed area or from 
metastatic lesions of the liver or lungs shows the presence of typical 
necrosis bacilli in great numbers. In the case of organic lesions these 
filaments are seen to be arranged along the border of the area of 
necrosis, whereas the central portion is amorphous and does not reveal 
the presence of any microorganisms. 

Intravenous metliod. — The intravenous method of inoculation was 
adopted in nine cases, four of which resulted in the death of the 
animal. Each rabbit received in the posterior auricular vein 0.3 c. c. 
of an emulsion of the tissue filtered through cotton, the filtrate con- 
taining numerous bacilli. 

The course of the disease ranged from seven to twelve days. The 
symptoms exhibited in all cases were the same as those induced by 
subcutaneous inoculation and consisted of gradual emaciation followed 
by the loss of appetite and by convulsions, paralysis, and death. The 
postmortem examination showed the principal lesions to be located in 
the thoracic cavit3\ The lungs contained several caseous nodules the 
size of peas surrounded by a hemorrhagic zone, and in one rabbit the 
left principal lobe was adherent to the costal pleura by a thick, 
purulent exudate. In each case the costal pleura contained several 
metastatic foci and the chest muscles in two instances were the seat of 

Description of Plate 3. 

Section of lung of rabbit No. 1197, inoculated subcutaneously with a bouillon culture 
of Bacillus necrophorus, showing four metastatic foci. Stained with Lo filer's methylene 
blue. Magnified al)out 25 diameters. 

Description of Plate 4. 

Section of lung of rabbit No. 1197, showing the superior focus in plate 3 greatly 
amplified. Notice the felted network of wavy filaments and smaller forms of Bacillus 
necrophorus. Stained with Loffler's methylene blue. Magnified about 450 diameters. 

Description of Plate 5. 

Fig. 1. ^Cover-glass preparation from a metastatic focus in the wall of the left 
ventricle of rabbit No. 1219, which died on the fourteenth day following a subcutaneous 
injection of a Martin's bouillon culture of the necrosis bacillus. Stained with Ziehl's 
carbol-fuchsin. Composite drawing made with camera lucida at base of stand with 
Zeiss No. 6 compensating ocular, 2 mm. oil immersion objective and 160 mm. tube 
length. 

Fig. 2. — Photograph of Petri dish containing numerous characteristic colonies of 
necrosis bacilli forty-eight hours after their inoculation into bouillon agar and fol- 
lowing their inculcation at 39° C. in a closed jar containing pyrogallic acid. Notice 
the gas formation and the fluffy outlines of the colonies, with their dark dense centers. 



Bulletin No. 67, B. A. I. 



Plate 3. 




^.\0 






^' 



Section of Lung of Rabbit Showing Metastatic Foci. 



Haines del 



Bulletin No. 67, B. A. I. 



Plate 4. 



r 



^'^ 



%, V^ 






* •!,. 




4/* ^j'' 



* / 

/ 



t,^wr 




Section of Lung of Rabbit Showing Felted Network of Bacillus necrophorus. 



Haines del 



Builstin No. 67, B. A. I. 



Plate 5. 




FiG. 1.— Bacillus necrophorus from Metastatic Focus in Rabbit's Heart. 




Fig. 2.— Petri Dish Containing Characteristic Colonies of Necrosis Bacilli. X 2. 



NECROTIC STOMATITIS. 25 

one or two localized areas of coagulation necrosis. In another the 
caseous process had included the entire surface of both lungs, the 
pericardium, and the heart itself until all were superticially fused into 
one chees,y mass. The liver of one animal contained eight superticial 
areas of caseation varying in size from a pea to a hazelnut and was 
adherent to the diaphragm and abdominal muscles. All other organs 
were normal. No lesion was observed about the point of inoculation 
in three cases; the fourth showed a narrow strip of necrosis along the 
line of the vein for about half an inch. Cover-glass preparations 
made from the lesions contained numerous characteristic specimens of 
Bacillus n ecrophor m. " 

Experiments on Mice. 

Sithcutaneous ?V?oci/ia^/w?.— The remarkable susceptibility of a white 
mouse to "necrophorus infection'' makes this animal an excellent 
medium for the preservation of the virulence of that microorganism, 
as well as a means of obtaining it in pure culture. Unfortunately, 
this animal's extreme susceptibility to many forms of the bacterial 
flora of the mouth disqualities it for use in the early stages of an 
investigation. The inoculation experiments may be carried on In- 
placing a small bit of necrosed tissue into a pocket in the skin of the 
back, or by injecting into the same region 0.1 c. c. of a fluid culture 
or emulsion containing the germ in a pure state. In two to four days 
the point of inoculation is covered with a rather thick, blackish, or 
dark-brown dry scab around which is a zone of redness. Beneath this 
scab proceeds a coagulation necrosis spreading through the subcutane- 
ous tissues until the mouse is completely mummifled, shriveled up. 
and covered with a dry parchment-like coating; or. penetrating into 
the body cavities in its course, successively caseates muscle, cartilage, 
bone, and viscera. In some of these cases so general becomes the 
caseous process that it is difficult to decide whether the viscera have 
suffered embolic necrosis or have become involved in the progressive 
caseation through extension by contiguity. In cases in which necrotic 
action was less widespread, small focal necroses containing the Bacillm 
o^ecrophorus in pure culture were found in the lungs, liver, and spleen. 
In our experiments mice have died as early as five, and as late as 
twenty-one days. 

« While these pages were in press an interesting experiment in natural infection 
was completed. Rabbit 1262 died, presenting a complete picture of Schmorl's dis- 
ease. It had been associated with an inoculated rabbit affected with a " necropho- 
rus " ulcer on the right ear, and was repeatedly noticed licking this sore spot. The 
necropsy revealed a necrotic stomatitis involving the gums, dental alveoli, body of 
the inferior maxillary, floor of the mouth, sublingual and submaxillary glands, and 
the tissues of the face and neck. There were no internal necroses. Cover-slip 
preparations and inoculations, both artificial and animal, demonstrated the presence 
of Bacillux necrophorus. 



26 BUREAU OF ANIMAL INDUSTKY. 

ExPERUrEXTS ON GUINEA PiGS. 

Guinea pigs were inoculated with pure cultures of necrosis bacilli 
by both the subcutaneous and intraabdominal methods, but these 
were followed by negative results. Nine animals were used in the 
experiments, and doses ranging from 0.25 to 1 c.c. of a forty-eight-hour 
bouillon culture were injected without producing any unfavorable 
effects. However, one positive result was obtained with guinea pig No. 
3181, which was injected intraabdominally with 0.5 c.c. of an emulsion 
of the necrosed tissue taken from the mouth of calf No. 3. Death fol- 
lowed on the tenth day. On autopsy the carcass appeared emaciated. 
The point of inoculation in the prepubic region was surrounded by an 
abscess several millimeters in diameter containing a rich yellowish pus. 
In the linea alba several inches above this abscess was a metastatic 
nodule 1.5 cm. in diameter, involving the muscular tissue and the 
peritoneal lining. It contained the same character of pus. On the right 
side of the linea alba the peritoneum was adherent to the contiguous 
loop of the colon opposite the last rib. The right and left lobes of the 
liver were almost fused into one by abscess formation. The right lobe 
particularly was the seat of several abscesses 1^ cm. long ])y 1 cm. wide, 
with a line of demarcation plain and straight between the part abso- 
lutely necrosed and the invaded portion. The spleen appeared mot- 
tled and slightly enlarged, and the kidneys were deeply congested. 
The lungs were engorged on the right side and showed one or two 
foci of hepatization. The presence of Bacillus necrophorm in the 
liver abscesses was demonstrated by microscopic preparations and by 
animal inoculations. 

Experiments on Chickens. 

Four fowls were injected— two l^y intravenous and two by intra- 
muscular inoculations- with 0.75 c.c. of a forty-eight-hour Martin's 
bouillon culture, but in no case was the result fatal. Nothing was 
observed that would indicate that the birds had been injected, and after 
a period of two months they were chloroformed. The postmortem 
examination revealed absolutely healthy birds. 

e;xperiments on Pigeons. 

The inoculation of two pigeons indicated that the bacillus is not 
pathogenic for these birds. One pigeon was inoculated intravenously 
with 0.3 c.c. of a forty-eight-hour culture in Martin's bouillon, the 
other bird with 0.5 c.c. of a similar culture into the pectoral muscles. 
This experiment was concluded six weeks after its inauguration by 
chloroforming the pigeons, but in neither case was any abnormal 
condition apparent. 

EXPERIiMENTS ON CaLVES. 

Suheutaneous inoculations. — Heifer calf No. 351, 7 months old, was 
injected October 5, 1904, on the inside of. the upper lip with 1 c.c. 



NECROTIC STOMATITIS. 27 

of an emulsion prepared from the point of inoculation of rabbit 
No. 1215, which was the seventh in a series of animals inoculated with 
the material from a calf affected with necrotic stomatitis. 

October 7. — There is a slight reddening about the site of injection, with a temperature 
of 102.6° F. 

October 10. — The temperature has reached 103.2° F., and a large tumor with a soft 
center is observed at the point of inoculation. Pus can be seen oozing from the 
opening made by the needle in the lip. 

October 11. — There is an enlargement about 1 by 2 by 1 inch in size at seat of injec- 
tion, with an ulcerating surface surrounding the point of puncture. 

October 12. — The caseous nodule is about the same size, and is still suppurating. 

October 14. — The enlargement on lip does not appear to have increased any in size. 
An opening simulating a rodent ulcer about one-half inch in diameter has formed ( n 
the inner side of lip which leads to the pus cavity in the center of the necrotic area. 
Thick creamy yellow pus issues from it. 

October 17. — The pus has been evacuated from the abscess in lip, and the lesion has 
begun to heal. 

October 18. — The lesion in the mouth is healing rapidly, and the animal has been 
removed from the experiment. 

On Auoust 1-1, 1904, a fragment of necrosed tissue about one-half 
the size of a pea was inserted into a pocket made beneath the mucous 
membrane on the right side of upper lip of calf No. 31S, 4 months 
old. The tissue w^as taken from the seat of injection of rabbit No. 
822, the second in a series of rabbits inoculated with a pure culture of 
the Bacillus necrophonis obtained from the lip of a Berkshire shoat 
affected with necrotic stomatitis. 

August 15. — Temperature of the calf is 103.2° F., and an intiannuatory z(jne is noticed 
about the punctured mucous membrane. 

Atigust 17. — At the seat of inoculation there is a hard spheroidal enlargement 
about 1 inch in diameter. 

August 18. — The abscess at point of inoculation has not increased any in size. A 
plug of pus and necrotic material of one-half cubic inch in volume has been extruded 
from the caseous nodule in the mucous membrane at the seat of injection. 

August 19. — A small quantity of very thick pus is being secreted from the abscess. 
Temperature remains about the same as on previous days, 103° F. 

August 22. — Only a small ulcer with a slight reddening at seat of inoculation 
remains. Temperature 104.8° F. 

August 24. — Lesion is healing; appetite is good; temperature 104° F. 

September 1. — The ulcer at seat of inoculation has about healed. Temperature 
102.4° F. 

September 12. — Animal removed from this experiment. 

Roan calf No. 350, 2 months old, was inoculated May 24, 1904, on 
the lower portion of the left cheek with tissue taken from rabbit No. 
1015, which was one of a series of rabbits injected with the necrosis 
bacillus obtained from a case of foot-rot in sheep. 

May 26. — There is a reddening of the mucous membrane about the seat of injection. 
May 27. — The animal appears dull and languid and eats sparingly. The mucous 
membrane is of a grayish color and presents an ulcer about \h inches in diameter. 



28 BUREAU OF ANIMAL INDUSTRY. 

May 28. — A distinct and characteristic ulcer has formed, containing a caseous 
necrotic center surrounded by a zone of inflammation. From the caseous material 
scraped from the deeper portion of this ulcer rabbit No. 1117 was injected under the 
skin of the back. (This rabbit succumbed on the sixth day following, with charac- 
teristic lesions, from which the Bacillus necrophorm Avas obtained. ) 

May 31. — Point of inoculation in cheek of calf still shows ulceration, but swelling 
and inflammation are disappearing. 

June 11. — Healing is about completed, there being only a small, depressed ulcer 
remaining. 

Suhcutcmeo'us and intravenous inoculation. — On November 27, 1903, 
calf No. 337, 11 months old, was injected on the left side of tongue 
with 1 c.c. and inoculated in the right jugular vein with 5 c.c. of a 
culture of Bacillus nec7'02)horus obtained from necrotic stomatitis of 
calves. 

December 3. — The animal has remained perfectly well in every respect. No lesions. 
December 16. — The calf to all appearances continues well. 

December 26. — General condition remains good. Temperature has been normal 
throughout the experiment. 

Owing to the negative result of this experiment it mav be concluded 
that the animal in question was not susceptible to the injections, proba- 
bly on account of its age. 

Intravenous inoculations. — Gray calf, No. 359, was injected intra- 
venously (right jugular vein) with 10 c. c. of a culture of the Bacillus 
necrophorus obtained from necrotic stomatitis of calves. 

November 23. — The only reaction shown from the injection yesterday is the temper- 
ature of 103° F. 

November 24- — The temperature reaches 106.8° F. The calf is now very sick, walks 
with a staggering gait, and hock joints are flexed much more than normal. It 
trembles, and eats scarcely anything. 

November 25. — The animal shows about the same symptoms as yesterday, but more 
marked; pulse, 104. 

November 26. — It is considerably weaker than on November 25, and has difficulty 
in getting on its feet. Temperature, 107° F. 

November 28. — The condition is about the same; very weak, but can stand up; 
spiritless and refuses food. 

November 29. — The calf seems somewhat weaker and walks with a staggering gait. 
Temperature, 104.6° F. 

November 30. — It is still very weak and more stupid than yesterday; appetite is 
much improved. Temperature, 104° F. 

December 1. — It shows no improvement in general appearance, but has a much 
better appetite. 

December 2. — The condition is same as yesterday. Animal killed by bleeding. 

The postmortem examination held shortly after death showed the 
carcass to be in a rather poor condition and the hair and skin dry and 
harsh. On opening the thoracic cavity the lungs were found to con- 
tain a number of encapsulated caseous nodules scattered quite regu- 
larly in the peripheral and superficial portions of the lobes. There 
were nine such areas in the right lung and seven in the left lung. 
Four of these nodules were surrounded b}^ hemorrhagic zones, while 



NECROTIC STOMATITIS. 29 

the remainder bore a striking- resemblance to the early pulmonary 
lesions of caseous lymphadenitis of sheep, and were circumscribed by 
normal lung tissue. On sectioning the}^ were seen to contain a yel- 
lowish white, thick, rather dry mass, from Avhich the necrosis bacillus 
was obtained in purity. The liver showed three small superticial foci 
of necrosis the size of a grain of wheat, while the heart, spleen, and 
kidneys were apparently without lesions. No alteration of any kind 
was observed at the point where the intravenous injection was made. 
Culture media were inoculated with the caseous material from the 
necrotic areas in the lungs, and a rabbit was injected subcutaneously 
with similar material, with the result that characteristic development 
in the former case occurred within forty-eight hours, and in the latter 
case death of the rabbit followed on the eighth day with typical post- 
mortem lesions. 

EXPERIiMENTS ON SHEEP. 

Suhci(t(i7ieoiis hwculatiom. — On August 22, ll>0-i. a small fragment 
of necrotic tissue, obtained from the same source as that used on calf 
No. 318, was introduced into a pocket made under the mucous mem- 
brane of the right cheek of sheep No. 23, about 1 year old. 

August 24. — At the seat of inoculation in the mouth there is an inflammatory proc- 
ess which has caused a small ])atch of necrosis in the mucous membrane. Temper- 
ature 104° F. 

August ^6'.— The ulcerous area in the mouth has reached one-half inch in diameter 
and is secreting pus. The inflammation and swelling are somewhat reduced. Tem- 
perature 103.6° F. 

August 30. — The lesion at the point of injection is decreasing in size and the tem- 
perature of the animal is 102.4° F. 

September 1. — The ulcer has nearly healed. Temperature 102° F. 

September 9. — No lesion at seat of inoculation. Condition of animal is good. 

Sheep No. 102, pure Merino, born in the fall of 1902, was inoculated 
May 9, 1903, on the lower lip with a culture of necrosis bacillus obtained 
from necrotic stomatitis of calves. 

Maij 21. — No symptom of the disease has thus far appeared. 

June 1. — No lesions are to be seen in the mouth, and the sheep seems to be well 
and gaining flesh. 

June 5. — Animal is removed from experiment. 

Experiments on Pigs. 

Suhcutaneous inoculation. — On October 5, 1904, pig No. 1448, weigh- 
ing 50 i^ounds, was injected inside of upper lip on the right side with 
1 c.c. of the emulsion obtained from the same source as that used on 
calf No. 351. Following the injection the pig continued in good con- 
dition, and no alterations were observed at point of inoculation until 
October 12, when a small inflamed swelling was detected, which showed 
a small necrotic center. -By October 14 this enlargement had reached 
the size of a hazelnut, with a small ulcerative surface about 5 cm. in 



30 BITREAU OF ANIMAL INDUSTRY. 

diameter. The lesion remained stationary for several days, when 
healing started, and by November 2 the ulcer had almost disappeared. 
On November 12 the animal was in good condition, without any altera- 
tion at seat of injection. 

Pathology. 

The pathologic process which everywhere characterizes Bacillus 
necfophorus is a necrobiosis, involving coagulation necrosis with sub- 
sequent caseation, and marked by a progressive invasion of the sur- 
rounding (particularly the deeper) tissue and a remarkable tendency 
to metastasis. When this process is applied to a mucous membrane 
we have presented to us a diphtheric intiammation plus caseation. 

A discussion of terms at this point is necessary for clearness of definition. Tlie 
Greek (5z</)6iepa=di2ihthera, means membrane. According to usage in medical 
nomenclature "diphtheritis" should mean an inflammation of a membrane. It is 
unfortunate that this term, seldom used in English — more frequently used on the 
Continent — has been made synonymous with diphtheria. This latter term is used 
to-day to refer solely to that disease process evoked by the presence and activities in 
the tissues of the Klebs-Loffler bacillus. That process is characterized usually, if 
not quite always, l)y the production of a false membrane. At the time of the appli- 
cation of this term, and for years afterwards, it was supposed that etiologically, this 
process of inflammation characterized by membrane formation was always the same. 
Bacteriology has exploded this idea, and it is now known that this process can be 
provoked by numerous causes other than the Klebs-Loffler bacillus. We see no diffi- 
culty whatever in thus limiting the term diphtheria as above. 

The adjective "diphtheritic" very naturally and properly associates itself with 
"diphtheritis." Hence, so long as diphtheritis and diphtheria are used synony- 
mously so long will diphtheritic be associated with diphtheria as the qualifying 
adjective. So we find that among most writers a diphtheritic infiammation is an 
inflammation excited by the Klebs-Loffler organism. 

A "diphtheric" inflammation, however, is an inflammation characterized by the 
formation of a di(pf)EpLX, or membrane. It is not synonymous with diphtheria, and 
may be induced by a variety of causes— mechanic, chemic, and microbic — other than 
Klebs-Loffler bacillus. 

The name "calf diphtheria" is therefore incorrect when applied to necrotic 
stomatitis. The application of the adjective " dijihtheric " is almost as misleading, 
since it stops short of a complete pathalogic anatomy of the disease. 

The principal lesions in necrotic stomatitis occur in the mucous 
membrane of the mouth and pharynx. The alterations may extend 
to the nasal cavities, larynx, trachea, sublingual lymph glands, lung, 
esophagus, intestines, and hoof. The oral surfaces affected are, in the 
order of frequency, tongue, cheeks, hard palate, gums, and lips. In 
the majority of cases the primary infection appears to take place in 
the tongue. The manner of infection in very j^oung animals is con- 
nected, beyond all doubt, with the eruption of the first temporar}' 
teeth after birth or, in animals somewhat older, an inoculation which 
probably occurs most frequently ])y a sharp-pointed particle of food 
penetrating the mucous membrane. At the point of entrance the 



NECROTIC STOMATITiy. 31 

system recognizes the presence and multiplication of the bacilli by a 
reaction marked by congestion and reddening-, followed by an exuda- 
tion rich in albuminoids or tibrin-forming substances, and a defensive 
immigration of leucocytes. 

The metal)olic products of the bacilli are exceedingly poisonous, 
killing everything with which they come in contact. Hence, the first 
effect of the organism is a necrosis, or death, of the superficial layer 
of epithelial cells and leucocytes at the seat of invasion. The cells 
either suffer fragmentation of their nuclei or become transformed into 
irregular flaky masses — the so-called hyaline masses. This constitutes 
superficial erosion of the mucous membrane. The process never stops 
here, though we ma^- often recognize this .stage in numerous recent 
foci of necrosis in a rapidly spreading form of the disease. 

The second alteration is the production of false membrane bv a 
combination of coincident changes. On the one hand, the necrosed 
epithelial cells and leucocxtes, having lost their nuclei and finer struc- 
ture, are deprived of their normal granulation and striation and take 
on a scaly appearance, being converted into hyaline substance; on the 
other hand, the allnuninous exudate in which these dead cells are 
bathed precipitates fibrin or coagulates into fine threads. This is 
known a.s coagulation necrosis. The false membrane, then, is the 
result of coagulation necrosis of the inflammatory exudate and the 
entanglement in its meshes of the hyaline degenerated epithelial cells 
and leucocytes. This gives a grayish compact mass, more or less 
adherent to the underlying tissue which, by failure of the dead cells 
to be thrown off', may be built up an eighth of an inch or so. 

The third alteration connected with this process is due to an invasion 
of the deeper tissues. The bacilli are always found on the border line 
between the living and dead tissue. Here, in great bundles of beaded 
filaments, they may be seen attacking the healthy tissue, which in turn 
has erected against the attack a wall of leucocytes, while masses of 
micrococci, tangles of streptococci, and clumps of bacteria are lodged 
in the superficial layers (pi. 2, fig. 1). Thus the process is carried 
down into the stroma or connective-tissue framework, and by the 
death of these deeper tissues are formed ulcers of varving depth. 
These may be sharply circumscribed, or at times diffuse, with thick- 
ened, slightly reddened borders surmounted by several layers of this 
necrosed tissue. The ffoor of the ulcer is formed by a grayish-jellow 
corroded surface, under which the tissue is transformed into a dry, fri- 
able or firm chees}' mass. In the tongue caseation may progress to two 
fingers' thickness into the muscular portion; in the cheek it may form 
an external opening permitting fluids to escape from the mouth; upon 
the palate it frequently reaches and includes the bone in its destructive 
course; upon the gums it has produced necrosis of the alveolar proc- 
esses, causing loss of the teeth. By the coagulation necrosis occurring 



82 BUREAU OF ANIMAL INDUSTRY. 

ill the region of tlie blood vessels, they become obstructed by pressure 
or sometimes by thrombosis, and thus the dead tissue becomes avas- 
cular, and the necrotic mass undergoes pulverization into finer and 
minuter particles until it is a drv, crumbly, yellowish mass of tissue 
detritus resembling cheese. 

Symptoms. 

Necrotic stomatitis is both a local and a sj^stemic affection. Pri- 
maril}' it is local. The local lesion is the caseonecrotic patch or ulcer, 
developed as a result of the multiplication of the bacilli at the point 
of inoculation. The general affection is an intoxication or poisoning 
of the whole system, produced by a soluble toxin elaborated b}' the 
bacilli. 

The stage of incubation is from three to five days. Calves have 
shown signs of the disease when only three daj^s old. During this stage 
the animal organism is passive and manifests no symptoms. The stage 
of invasion is twofold — local reaction against the invading organisms 
and constitutional manifestations of intoxication. The first symptoms 
noted are disinclination to take nourishment and some drooling from 
the mouth. An examination of the mouth at this time maj' show on 
the mucous membrane of the tongue, hard palate, cheeks, gums, lips, 
or fauces a circumscribed area of infiltration and redness, possibly an 
erosion. The latter gradually extends in size and depth, forming a 
sharpl}^ circumscribed or at times a difi'use area of ulceration (pi. 1). 
It ma}^ measure anywhere from the size of a 5-cent nickel piece to that 
of a silver dollar or even larger. It has the appearance of a corroded 
surface, under which the mucous membrane or lingual tissue seems 
transformed into a diy, finel}^ granular, or firm cloddj^ mass. It is 
grayish j^ellow in color, and is bordered l)y a zone of thickened tissue, 
slightly reddened and somewhat granulated. The necrotic tissue is 
ver}^ adherent and can be only partially peeled ofl*. It is homogene- 
ous, cheesy, and may extend to the depth of one inch into the under- 
lying tissue, involving the muscular tissue or even the bones. The 
general sj'mptoms are languor, weakness, and slight fever. In spite 
of plenty of good food, the calf is seen to be failing. It stops sucking-, 
or, if older than a suckling, altogether refuses to eat. The tempera- 
ture at this time may be from 104° to 107° F. The slobber becomes 
profuse, swallow^ing ver}' diflacult, opening of the mouth quite painful, 
and a most offensive odor is exhaled. The tongue is swollen and its 
motion greatly impaired. Sometimes the mouth is kept open, per- 
mitting the tumefied tongue to protrude. One or more of the above 
symptoms direct the attention to the mouth as the seat of disease; or, 
having noticed the debility and disinclination to eat, an examination 
of the animal may show a lump under the neck or swelling of the 



NECROTIC STOMATITIS. 83 

throat or face as a result of the large partially- chewed boluses of food 
that have collected there. 

The following extract from a letter is characteristic: 

I noticed my calves beginning to fail about the first week in December, liut could 
not account for it, as thej^ were getting plenty of grain and hay. My attention was 
first attracted by a swelling under the neck of one of the calves. I cast the animal 
and found it was food that had collected and the animal couldn't swallow it. I 
removed the food, and in so doing noticed a large ulcer on the tongue and a very 
offensive odor. This was the first knowledge I had of anything being wrong with 
the calves' mouths. They may have been sick for sometime before this. 

Out of a herd of 100 belonging to this man, 70 were affected, and the 
letter emphasizes the insidious character of the onset. 

The general affection at this time manifests itself b}- dejectedness, 
extreme weakness and emaciation, constant lying down, with stiffness 
and marked difficulty in standing. 

The disease f requentl}^ extends to the nasal cavities, producing a 
thin yellowish or greenish yellow stick}^ discharge which adheres 
closely to the borders of the nostrils. Their edges also show caseous 
patches similar to those in the mouth. Sometimes the nasal passage 
is obstructed by great masses of the necrosed exudate, thus causing 
extreme difficult}' in breathing. When the caseous process involves 
the larynx and trachea, there result cough, wheezing, and dyspnea, 
together with a yellowish mucopurulent saliva. When life is pro- 
longed three or four weeks, caseous foci may be established in the 
lung, giving rise to all the signs of a broncho-pneumonia. Many of 
these cases are associated with a fibrinous pleurisy. The invasion of 
the gastrointestinal tract is announced by diarrheic symptoms. 

In pigs the symptoms are practicalh' the same as have been described 
for calves, although the tongue is not so likely to be involved. The 
mouth becomes necrosed in patches, especially in the region of the 
front teeth and tusks. Suppuration and destruction of tissue around 
the teeth may be so great that they finally become loosened and fall 
out. The jaws are swollen and the lips show cracks and scabs. The 
snout is frequentl}^ involved, resulting in some cases in necrosis of the 
end of the nose. The disagreeable odor exhaled from the mouth and 
the tendency of the affection to spread to the larynx, pharynx, and 
, tonsils, and the mucous membrane of the stomach and intestines are 
greater with pigs than with calves. When the intestines l)ecome 
involved, a black offensive diarrhea is manifested, the pigs are dull, 
refuse to suckle, and are inclined to remain recumbent. Prostration 
and emaciation are especially marked when the digestive and respira- 
tory organs are involved. 



34 bureau of animal industry. 

Course and Termination. 

In the very acute form of the disease man}^ of the cases run their 
course in five to eight days. In these the local lesions are not strongly 
marked, and death seems due to an acute intoxication. In other 
enzootics the majority of the affected animals live from three to live 
weeks. These are the cases that usuallj^ present the pulmonary and 
intestinal symptoms, and sometimes develop, in the case of bovines, 
caseonecrotic lesions of the liver. 

Infective Character. 

The consideration of this aspect of the disease involves a stud}- of 
its infectiveness for animals and also the question of its transmissibility 
to man. Under the former must be considered the infection of an 
isolated case or the initial infection of a group of cases, the transmis- 
sion of the disease from animal to animal of the same varietv or 
species, and its transmission from animals of one species to those of 
another. 

Necrotic stomatitis is enzootic — never epizootic; that is to say, 
instead of covering a wide area, like foot-and-mouth disease or pleuro- 
pneumonia in their march of devastation, it involves in its infection 
only the members of a few herds or the animals on a single farm. 
This is due largely to the nature of the infective agent. Being a 
strict anaerobe and not very resistant to germicidal influences, such 
as light, there is, under what are termed natural conditions, little 
possibility of the conveyance of the microbe from place to place. 
Another characteristic of the Bacillm necrophorus is that it is, strictl}^ 
speaking, a secondary invader. This requires special conditions of 
receptivity on the part of the animal infected. For example, there 
must be a break in the continuit}^ of the tissue to which the necrosis 
bacillus is applied. 

It should be stated here that the BaciUm necro])liorus is not to be 
regarded as a saprophytic guest of the intestines of hogs and herbivora 
which, under certain conditions, develops pathogenic properties. It is 
always and everywhere the producer of a progressive tissue necrosis 
characterized by caseous degeneration. Whether in or out of the 
intestine, whether in manure on the stable floor, or buried deep in 
the tissues of a susceptible animal, it always possesses this patho- 
genic property. But in the lumen of the intestine, possessing an 
intact epithelial lining, the necrosis bacillus is, for the time being, 
without effect. However, let this epithelium be injured by a foreign 
body, by corrosive fluids, by the action, for instance, of the hog cholera 
bacillus, and at once an entrance into the intestinal wall is afforded the 
necrosis bacillus, with the result that there develop diarrhea and caseo- 
necrotic patches in the intestines. This relationship of the intact epi- 
thelial covering to bacteria normally present in the intestine was well 



NECROTIC STOMATITIS. 35 

brought out in Jensen .s experiments on calves with reference to white 
scours. 

As to the infection of a single calf or pig or the initial infection of a 
herd, it is evident that, inasmuch as the BacUIvs necrophorm is a normal 
inhabitant of the intestine of healthy hogs and presumably of cattle, 
the manure may be looked upon as the chief agent in transmission. 
Hence a most common method of infection in the calf or pig, when the 
gums are abraded or torn in connection with the eruption of the teeth, 
is suckling the cow or sow when the teats are tilthy with manure. 
Again, the animal munching a little hay or straw which has been con- 
taminated with manure may receive a stab at souie point of the mucous 
membrane of the mouth by which the necrosis l)acillus is introduced 
into the tissues. 

The transfer of the disease from one animal to another occurs time 
after time when newly born animals are placed successively in a pen 
previousl}^ occupied by an animal that had contracted the disease. In 
this connection it must be remarked that the question is not alone 
that of the transmission of the disease of necrotic stomatitis, but of 
the transfer from one animal to another of the infective agent. In 
whatever part of the animal bod}" the Bacillus ^lecrophorics may have 
instituted the caseonecrotic inflammation which characterizes its patho- 
genic role, by whatever name the disease process ma}" be called, be it 
foot-rot, necrotic quittor, necrotic scratches, necrotic vaginitis, or 
metritis or necrotic stomatitis, there we find a hot))ed of infection and 
the certain groundwork of an enzootic. Hence the occupancy of the 
calving stall by a cow affected with panaritium or by a cow suffering 
with a vaginitis dependent upon this bacillus is sufficient to insure the 
development of a series of cases of necrotic stomatitis. The same 
principle is involved in the dissemination of the disease through one 
or more litters of pigs. The very first investigator in this line made 
the experiment of placing a healthy calf in a stall with two calves 
affected with the disease. The third calf came down in five days with 
the same malady. The author considered the calves' habit of licking 
one another as being chargeable with the transmission of the disease. 
Blazekovic ^ also reports an unintentional experiment of the same sort. 
The exposed calf began to cough in three or four days, after which 
the necrotic patches were visible in its mouth. It is also recognized 
that the practice of feeding calves from the same vessel or bucket and 
pigs from the same trough may be responsible for the transmission of 
the affection. 

The proof of the transmissibility of the disease from one species to 
another was secured by Dammann," who inoculated a bit of necrotic 
material from the mouth of a calf, dead with the disease, into the 
mouth of a four-days-old lamb. In four days the lamb died, with 
postmortem findings which established the success of the experiment. 



36 BUREAU OF ANIMAL INDUSTRY. 

It may safel}' be assumed that any species which has shown a suscepti- 
bility to the bacillus in any portion of the body may be attacked with 
necrotic stomatitis, the conditions for the inoculation of the germ 
being present. 

The study of the transmissibility to man of necrotic stomatitis of 
animals involves not onl}' the question of the pathogenicity for man of 
the infective agent of necrotic stomatitis, but also that other interest- 
ing and important question of the relation of animal diphtherias to man. 
This latter question will be treated separately. The former question 
is not realh' involved in the latter because, as we have shown, necrotic 
stomatitis is not a diphtheria. Still, of interest are the questions, 
Can man contract disease from cases of necrotic stomatitis in animals? 
Is BdctUus neerophorus pathogenic for man? An affirmative answer 
to the second makes probable an affirmative answer to the first. 

No help in answering the questions can be gathered from Dammann's 
experiences, since in his cases it was also the question of a virulent 
micrococcus infection, and the sore throats in men referred to by him 
were no doubt infections of this sort. However, Schmorl records the 
case of himself and servant in the laboratory, both of whom developed 
small digital abscesses, in the contents of which were demonstrated both 
micrococci and undoubted forms of BaciUvs necfophorus. When it is 
remembered that guinea pigs, ordinarily immune, may be successfully 
infected with Bacillus necr'ophorus when the tissues have been previ- 
ously invaded by a micrococcus, it is readily seen that, under like cir- 
cumstances in man, the necrosis bacillus might play the role of a secondary 
invader. Right here it must be remembered that, as already referred 
to, Loffler had met with Bacillus necrophorus^ not only in his calf- 
diphtheria investigation, but also in some experiments looking toward 
the transmission to rabbits of syphilitic products. Out of four rab- 
bits inoculated in the.anterior chamber of the eye with bits of a condy- 
loma latum, two died with local and metastatic necrosis, exhibiting the 
characteristic bacteriological pictures of Bacillus necropJiorus. Loffler 
also makes the statement that he had several times seen, in addition 
to others, similar bacteria in the surface exudate of ulcerating condy- 
lomata lata, and that such bacteria were also present in the exudate of 
the inoculated condjdoma. Jensen makes the suggestion that the 
deeply penetrating necroses, for example, of the intestine after typhoid 
and scarlet fevers, of the throat in scarlet fever, of the cheeks (noma) 
after scarlet fever, measles, etc., of the fingers in panaris, ofler inter- 
esting fields of investigation with reference to the presence of Bacillus 
necrophorus in man. 

SUSCEPTIBIIJTY. 

Necrotic stomatitis attacks principally sucklings not over six weeks 
of age, but calves and pigs eight to ten months old are frequently 



NECROTIC STOMATITIS. 37 

affected, and several cases of adult cattle showing the disease have ])een 
reported in the works of Bang/ Jensen,''" Berg,^ and others; also in 
two-years-old hogs in our correspondence from pig raisers. More- 
over, Dammann/'' Loffler,*' and Diem ^~ have noticed the natural 
occurrence of this affection in lambs. The presence of the disease in 
various other species has already been referred to in a previous chap- 
ter. Sex and breed play no role in reference to this malady, as it is 
not confined to either male or female nor to any particular breed or 

breeds. 

Economic Importance. 

Although occasional reports of a rapidly fatal disease affecting the 
mouths and throats of calves have been forwarded to this office from 
various sections of the West during several years past, no fresh mate- 
rial for an investigation into the nature and cause of ,the affection 
could be procured until 1902 and 1903, when a number of rather 
severe outbreaks occurred in Colorado, western South Dakota, and 
eastern Wyoming. From the history, svmptoms, and lesions of the 
affected animals described in these letters, it seemed probable that the 
disease was the so-called calf diphtheria of Europe, but this suspicion 
could not be veriffed until specimens of the diseased heads of calves 
were received through Dr. A. B. McCapes, at that time State veteri- 
narian of Colorado, to whom we extend our thanks. Very little is 
positively known of its prevalence in this country, owing to the lack 
of familiarity of stock owners and veterinarians with the disease, l)ut 
it is doubtful if its appearance here is of recent origin. The ver}- fact 
that the causative ^geut {Bacillus vecroph(>rt's)oi this disease has also 
been isolated in this laborator}^ from alxscesses iii the livers of cattle 
slaughtered at Kansas City and Chicago, from the liver of a deer from 
the National Zoological Park, and from sheep affected with foot-rot. 
would indicate that the organism is widespread in this country-, only 
awaiting an opportunity for entering the tissues of a susceptible 
animal. 

In reviewing the economic importance of this disease, considera 
tion must be given to the other infections produced by BadUns- 
oiecrophoynis, some of which are even more grave than necrotic 
stomatitis. The presence of the latter disease on a farm would indi- 
cate the possibility of the causative germ affecting other susceptible 
animals in tissues already referred to in the chapter on pathogenesis. 
Thus the importance of this organism is far beyond even its relation 
to necrotic stomatitis of calves and pigs since foot-rot of cattle and 
sheep, necrotic inflammation of the uterus and vagina of cows, a simi- 
lar inflammation of the large intestine, and necrotic scratches of horses, 
gangrenous processes of the lips and nose, and necrotic stomatitis in 
sheep, may all follow on premises contaminated with the infectious 
principle of this disease. Among the letters that have been received 



38 BUREAU OF ANIMAL INDUSTRY. 

requesting information relative to this malad}^ the following will con- 
vey a general idea of its nature and importance: 

Within the last two weeks several complaints from different parts of the State, 
mostly from the mountain regions, have come into this office regarding a disease in 
calves that were dying from sore month. I have just returned from Gunnison, where 
I examined several calves that died of this disease. I found that at the base of 
the tongue and in the larynx there were large sores, some of them as large as a silver 
dollar. They presented a thickened croupous matter usually white in color. After 
this matter was scraped off with a knife, a red granulated membrane was left. The 
owner told me that in some cases these sores appeared on the anterior part of the 
tongue, but in the cases I saw they were at the base of this organ. The trouble 
occurs in sucking calves of one to three months old. The first symptoms noticed are 
that they can not swallow, and soon cease to nurse. In calves that are old enough 
to eat hay or other forage, large boluses Of food are found between the lips and teeth, 
giving the apjiearance of a large swelling on the side of the face. Practically speak- 
ing, 90 per cent of the affected calves have died. One party lost 21, another 10, with 
no cases recovering on their fainis. 

Another correspondent from Salida, Colo., writes: 

We have lost 33 calves with throat and mouth disease and will lose more. 

A stock owner, writing from Lithia, S. Dak., states: 

There is a disease attacking my calves and which is new to the cattlemen of this 
vicinity. The calves stop eating; about three days after they begin to foam at the 
mouth, but continue to move their mouths. The throat swells very hard and the 
jaws are set tight, so that they can not open. A foam}^ pus discharges from the nose 
two days before they die, and they seem to strangle to death from accumulation of 
this pus in the nose and throat. They have high temperature and stand up and lie 
down alternately during the last two days. The bowels move freely and there is a 
tendency to urinate frecjuently. Death occurs in four or five days. Upon cutting 
into the throat or larynx and nasal cavities, they were found completely filled with 
thick pus. The muscles around the larynx and throat and back and under the 
tongue seemed to reseml)le the contents of an abscess. The heart and lungs seemed 
to be in their natural condition. I now have 7 head that have this disease. 

From Aladdin, Wyo., the following was received: 

A disease has broken out among my calves. I have 117 head and I believe half 
of them have sore or ulcerated tongues. I can not see that they are affected other- 
wise. The sore is generally located on the top of the tongue about the center and in 
some cases has eaten the tongue nearly in two. Two head have died, and in one of 
them nearly the entire surface of the back half of the tongue had rotted awaj' and 
contained numbers of cavities filled with pus, but I could not find any foreign sub- 
stance in them. 

A letter from Belle Fourche, S. Dak. , indicates that the disease is 
amenable to treatment. 

There are a number of herds (calves) affected in this country, and I know of 1 
cow. I have been using boracic-acid wash for mine, and they seem to be improving. 

A ranchman sends the following record of his observations from 
Bixby, S. Dak.: 

All of my calves and some of my yearlings have some kind of a disease. Their 
jaws swell and sometimes their throats, and when I come to examine them I find 



NECROTIC STOMATITIS. 39 

that their jaws are sore on the outside of the grinders and inside the cheek. In 
some it rots holes in their tongues, mostly at the back part. The breath smells 
terribly and the calves get dumpy and poor. 

A letter from Mason ville, Colo., sng-g'ests the possibility of the 
disease originating from foot-rot in cattle. 

I should like your opinion of what might be called an epidemic among my calves. 
Three of them have been attacked with swellings in the lower jaw on both sides. 
Yesterday one of the calves died, and on examining the jaw^ I found it apparently 
rotten on the inside from the grinders down. There was no pus. Last summer I 
noticed a calf of this same herd similarly afflicted, but it came out all right. Last 
summer about 10 per cent of my cattle were troubled with their feet cracking 
between the hoofs. They became very lame. 

Mr. G., of Wheatland, Wyo., requested— 

information regarding some young calves I have. There are 2 calves less than a 
month old running with their mothers. One of them has his jaw swollen up on one 
side. The other calf has both sides of the jaw and under the jaw swollen. I exam- 
ined their mouths and found "canker" alongside and behind their teeth, and it was 
awfully offensive. A few weeks ago I lost one six-months-old calf with a similar 
disease. 

Many cases of sore mouth in pigs are reported from various sec- 
tions of this country, and, assuming that these cases were similar to 
those investigated by us, it would seem that this disease causes the 
death of man}^ young animals and also stunts the growth of many that 
survive. Almost ever}^ pig in the litter suffers, and litter after litter 
becomes affected. The same lack of recognition of the disease as in 
calves prevents any accurate description of the importance of the 
affection in pigs, but in a few outbreaks observed it was noted that 
from 60 to 90 per cent of the animals in the herd died if left untreated. 
The disease in pigs, while usuall}^ affecting the young, has been 
reported at all ages, from sucking pigs one week old to hogs two 
years of age. One writer reports a loss of 33 out of 50, another 33 
out of 37, while a third states that of 12 four-months-old shoats 11 
succumbed to the disease. 

Differential Diagnosis. 

Necrotic stomatitis mav be differentiated from foot-and-mouth dis- 
ease by the fact that in the latter malady there is a rapid infection of 
the entire herd, as well as of any hogs or sheep that may be on the prem- 
ises; it is also highly infectious, spreading rapidly to neighboring 
herds and to cattle of the same herd. The characteristic lesion of 
foot-and-mouth disease is the appearance of vesicles containing serous 
fluid in the mouth, upon the udder, teats, heels, and coronary bands of 
the affected animals. Drooling is profuse, and there is a peculiar 
smacking sound made by sucking the affected lips. In hogs the 
mouth is not so likely to be affected as are the feet. Foot-and-mouth 



40 BUREAU OF ANIMAL INDUSTRY. 

disease has appeared in this country on four occasions onl3\ always 
near a seaport, and does not exist in the United States at the present 
time. In necrotic stomatitis vesicles are never formed, necrosis occur- 
ring- from the beginning- and followed by the formation of yellowish 
patches, principally in the mouth. 

M^'cotic stomatitis is a sporadic disease which atl'ects cattle of all 
ages that are on pasture, but more especially adult animals. It is 
characterized by inflammation and ulceration of the mucous membranes 
of the mouth, producing salivation and inappetence, and, secondarih', 
afl'ecting the feet, which become sore and swollen. Superficial erosions 
of the skin, particularh' of the muzzle, and of the teats and udder of 
cows may also be present. It occurs onl}" in a few animals of the 
herd, usually in the earl}' fall after a dry summer; it does not run a 
reg'ular course and can not be inoculated. 

Actinomycosis of the tongue ma}" occur as superficial erosions but 
is usually deep-seated, where, instead of producing ulceration and 
destruction of the mucous membrane, it causes a difl'used induration 
of the muscular tissue of the tongue, resulting in an enlargement of 
that organ. Hence the term '"wooden tongue'' has been applied to 
this condition. The course of the disease is chronic and the tongue is 
extensively affected before attracting the attention of the owner. The 
indurated tissue when incised is found to be hard and gritty and con- 
tains bright yellow sulphur-like granules of actinomyces, which are 
the causative agents of the disease. 

Prognosis. 

Ordinarily animals affected with necrotic stomatitis show no tend- 
ency to spontaneous cure. Left to themselves, they either die or 
become permanently stunted in growth. On the contrary, if taken in 
hand early, the disease is readily amenable to treatment. In the latter 
event the prospects of recovery are excellent, and under favorable con- 
ditions it takes place as a rule in twelve to fifteen days. 

Treatment. 

prophylaxis. 

Prophylaxis should be carried out along three lines: (1) Separation 
of the sick from the healthy animals; (2) close scrutiny and thorough 
disinfection once daily for five days of the mouths and nasal passages 
of those animals that have been exposed by the eruption of the first 
teeth, by the shedding of the milk teeth, or through association with 
affected animals; (3) complete disinfection of all stalls, sheds, and 



NECROTIC STOMATITIS. 41 

farrowing pens with a 5 per cent solution of carbolic acid to which 
has been added sufficient lime to make the disinfected area conspicuous. 
The disease appears to break out in winter and holds over to spring. 
It is conceivable that exposure to cold might so disturb the normal 
circulation of the oral tissues as to make the mucous membrane an 
excellent location for the development of the causative factor of the 
disease. There is another possibilit}^ however, which bears on the 
third line of prophylaxis. The diphtheric inflannnation of the vagina 
and uterus in cows is caused by the same organism that induces 
necrotic stomatitis. Ellinger ^^ has recently pointed out the almost 
constant relation of such attacks to previous occurrences of foul-foot 
or foot-rot in the same or other cattle on the place. In all likelihood, 
the stalls and sheds are the harborers, in such cases, of this germ. 
Wh}' may it not be that many of these outbreaks of necrotic stomatitis 
in calves have some relation to preceding cases of the above-mentioned 
diseases and the greater use in winter of stalls and sheds harl)oring the 
Bacillus necrophorus; and in pigs to the fact of their following cattle 
affected with one of the above diseases'^ 

THERAPEUTICS. 

The treatment consists almost solely in careful and extensive cleansing 
and disinfection of the mouth and other affected surfaces. The mucous 
membrane of the mouth should be copiously irrigated with a 2 per cent 
creolin solution in warm water. This should be performed at least 
twice daily, but care should be used with this as with all other antisep- 
tics, to prevent swallowing of any considerable quantity of the solution. 
Since exposure to oxygen kills the bacilli one need have no fear al)out 
disturbing or tearing off the caseous patches or necrotic tissue during 
irrigation. The irrigation of the sores should be followed by the 
application with a brush or rag on a stick of a paste made with 
salicylic acid 1 part and glycerin 10 parts; or the affected spots may be 
painted with Lugol's solution of iodine (iodine 1, potassium iodide 5, 
water 200). Frequent injections into the mouth of a 1 per cent car- 
bolic-acid solution make an excellent treatment. In calves the inter- 
nal administration of 2 grams of salicylic acid and 3 grams of chlorate 
of potash three times a day has also proved very benelicial. 

A very simple and efficacious method of treating pigs is to catch 
them and hold their heads for a few moments in a solution containing 
in each gallon of water 2 ounces of potassium permanganate, or in a 
solution of creolin of like strength. This treatment ma}' be repeated 
twice daily for six daj's. 

If the predisposed animals are sucking, it would also be advisable to 
batbe the udder and teats of the cows or sows with a 5 per cent solu- 



42 BUREAU OF ANIMAL INDUSTRY. 

tion of carbolic acid in order to prevent infection from tlie probably 
contaminated manure on these parts. In animals that have been 
weaned it will be necessar}" to feed soft, nutritious food, such as whole 
milk, bran mashes, ground feed, and gruels, and to keep clean, cool 
water constantly within reach. 

Kelation of Animal Diphtheeias to Man. 

We have already shown that the cause of necrotic stomatitis and 
the cause of human diphtheria are entirely distinct microorganisms. 
We have also shown that the disease process in necrotic stomatitis 
of animals is markedly difl'erent from that in human diphtheria. A 
superficial resemblance in the local manifestations of the two diseases 
and a total misconception of the cause of each gave rise to an identity 
of terms which is confusing. As we have elsewhere stated, calf 
diphtheria is a misnomer, false in its characterization of the disease, 
and misleading in its effect upon the mind of the public. The same 
statement holds with reference to so-called chicken diphtheria, or 
roup, and similar affections in avian species. Many different species 
of the mammifeis have revealed disease processes in mouth and throat 
that superticially resemble the diphtheritic process in man, but the 
weight of evidence at the present time goes to show that the patho- 
logical alteration in man}^ of these cases is not identical with that in 
human diphtheria. However, satisfactory proof has been offered of 
the recover}^ of the bacillus of diphtheria from a few isolated cases, 
especially in the cat, horse, and dog. At this point we would remind 
the reader that in the human famih^ diseases of the mouth, throat, 
and upper air passages frequentl}" arise which closely simulate diph 
theria, giving rise to almost identical clinical manifestations, but 
which upon bacteriological examination fail to yield the Klebs-Loffier 
bacillus, thus proving them to be distinct from diphtheria. In view 
of the apparent resemblance between the true and false diphtherias of 
man and animals, and because the former disease appears to be inter- 
communicable between man and animals, we urge upon the reader the 
isolation of all animals, particularly pets, affected with mouth and 
throat diseases, and the most punctilious observance of all details of 
sanitary precautions. 

Disposition of Meat of Affected Carcasses. 

If necrotic stomatitis were transmissible to man, the germicidal 
action of cooking might be counted on to obviate such danger. Proof 
that necrotic stomatitis is not transmissible to man does not demon- 
strate that the meat of animals so affected is fit for food. Other fac- 
tors enter into this question of the edibility of such meat. The disease 



NECKOTIC STOMATITIS. 43 

ma}' be regarded as at tlie lirst a local affection. Now it is manifest 
that those portions of the animal body affected with caseonecrotic 
patches should be condemned for food. The remaining- portions of 
the carcass, however, if in a good state of nutrition, might be placed 
on the market. 

On the other hand, should the disease have progressed beyond the 
condition of localization to a condition of toxinemia, which would be 
evidenced by emaciation, enlargement and discoloration of the lymph 
nodes, and cloudy swelling of the liver, the carcass should be rejected 
as both innutritions and noxious. 

Conclusion. 

We ma}' note that in necrotic stomatitis of animals we have to do 
with an acute, infectious inflammation of the mouth and upper air 
passages, of widespread occurrence both geographically and zoologic- 
alh", caused by the invasion locally of a thread bacterium, the 
Bacilhts necrophoTux^ a nonmotile, poh^morphic anaerobe, inhabiting 
normallv the intestinal tract of hogs and, in all probability, of herbiv- 
ora, and found also in manure. 

The disease is observed most frequentlv in calves and pigs, and 
usually in connection with the eruption of the lirst teeth, although 
other injuries of the mucous membranes may ])e the starting point. 
The disease process is a clearly defined cheesy degeneration of a pro- 
gressive coagulation necrosis characterized by the formation of ulcers 
and caseonecrotic patches, and manifesting itself clinically by saliva- 
tion, refusal to suck, difficult breathing, and rapid emaciation. The 
duration of the disease is from five days to five weeks, these animals, 
if untreated, dying early with a toxinemia. Necrotic stomatitis is not 
difficult of diagnosis and may quite easily be differentiated from other 
inflammations of the mouth, is most amenable to treatment, and hence 
offers a highly favorable prognosis. The exquisitely infectious nature 
of the cause rendering most easy the rapid development of an enzootic, 
and favoring the spread of other forms of bacillary necrosis, some of 
them even more grave than necrotic stomatitis, lifts the disease to a 
high place in agricultural economics. Evidence is not at hand for 
pronouncing it transmissible to man, and it is absolutely distinct from 
human diphtheria. 



44 BUREAU OF ANIMAL INDUSTRY. 



BIBLIOGRAPHY. 

Ill the bibliography appended all the works referred to in the text have been given 
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Om aarsagen til lokal nekrose. Maanedssk. f. dyrl., bd. 2, p. 235. KJ0ben- 
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Referat by C. O. Jensen. Ueber die ursache der nekrose. Cent. f. bakt., 
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De l)akteriologische forhold ved svinepesten. Maanedssk. f. dyrl., bd. 4, p. 
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Referat by C. O. Jensen. Cent. f. bakt., bd. 13, no. 5-6, pp. 20.3-205. 
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Gangra^n0s mundbettendelse hos k0er. Maanedssk. f. dyrl., bd. 8, no. 6, pp. 
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Die lebernekrose bei rindern. Arch. f. wissensch. u. prakt. thierh., bd. 21, 
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Znr kenntniss der kiilber-diphtherie. Deut. ztschr. f. thiermed., bd. 4, no. 
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Diphtheritis bei liunmern. Woch. f. thierh. u. viehz., jahrg. 41, no. 36, p. 
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NECROTIC STOMATITIS. 45 

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Idem. Ed. 3, 2 v., 1896. (See p. 61, theil 2, (Streptothrix cuniculi, Schmorl). ) 

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46 BUKEAU OF ANIMAL INDUSTRY. 

(27) Imminger. 

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NECROTIC STOMATITIS. 47 

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48 BUREAU OF ANIMAL INDUSTRY. L 

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